Loss, Grieving, Death and Post Mortem Care

LOSS, GRIEVING,DEATH
AND POST MORTEM CARE
BILL CONRAD C. ADRICULA, RN

OBJECTIVES:
1. TO DISCUSS LOSS AND GRIEF, TYPES AND SOURCES OF
LOSS, AND ASPECTS OF GRIEVING
2. TO ENUMERATE THE STAGES AND PHASES OF
GRIEVING ACCORDING TO DIFFERENT THEORIES.
3. TO DISCUSS DYING AND DEATH, THE SIGNS OF DEATH
AND POST MORTEM CARE.
HAVE YOU EVER EXPERIENCED LOSS,
GRIEF, OR DEATH OF LOVED ONES?
WHAT WAS YOUR INITIAL REACTION?

LOSS AND GRIEF
LOSS IS AN ACTUAL OR POTENTIAL SITUATION IN WHICH
SOMETHING THAT IS VALUED IS CHANGED OR NO LONGER
AVAILABLE. PEOPLE CAN EXPERIENCE THE LOSS OF BODY IMAGE,
A SIGNIFICANT OTHER, A SENSE OF WELL-BEING, A JOB, PERSONAL
POSSESSIONS, OR BELIEFS.
DEATH IS A LOSS FOR BOTH THE DYING PERSON AND FOR THOSE
WHO SURVIVE. ALTHOUGH DEATH IS INEVITABLE, IT CAN
STIMULATE PEOPLE TO GROW IN THEIR UNDERSTANDING OF
THEMSELVES AND OTHERS.
TYPES AND SOURCES OF LOSS
• THE TWO GENERAL TYPES OF LOSS ARE
ACTUAL LOSS AND PERCEIVED LOSS
• AN ANTICIPATORY LOSS IS EXPERIENCED
BEFORE THE LOSS ACTUALLY OCCURS.
• LOSS CAN BE VIEWED AS SITUATIONAL OR
DEVELOPMENTAL.
TYPES AND SOURCES OF LOSS
• THERE ARE MANY SOURCES OF LOSS:

A. LOSS OF AN ASPECT OF ONESELF ( A BODY PART,
PHYSIOLOGIC FUNCTION, OR PSYCHOLOGICAL
ATTRIBUTE)
B. LOSS OF AN OBJECT EXTERNAL TO ONESELF
C. SEPARATION FROM AN ACCUSTOMED
ENVIRONMENT
GRIEF, BEREAVEMENT, AND MOURNING
• GRIEF IS THE TOTAL RESPONSE TO THE EMOTIONAL

EXPERIENCE RELATED TO LOSS. IT IS MANIFESTED IN
THOUGHTS, FEELINGS, AND BEHAVIORS ASSOCIATED
WITH OVERWHELMING DISTRESS OR SORROW.
• BEREAVEMENT IS THE SUBJECTIVE RESPONSE
EXPERIENCED BY THE SURVIVING LOVED ONES.
• MOURNING IS THE BEHAVIORAL PROCESS THROUGH
WHICH GRIEF IS EVENTUALLY RESOLVED OR ALTERED.
TYPES OF GRIEF RESPONSE
• A NORMAL GRIEF REACTION MAY BE ABBREVIATED OR
ANTICIPATORY.
• DISENFRANCHISED GRIEF OCCURS WHEN A PERSON IS
UNABLE TO ACKNOWLEDGE THE LOSS TO OTHER PEOPLE.
• UNHEALTHY GRIEF IS A PATHOLOGIC OR COMPLICATED
GRIEF IS APPLIED TO PEOPLE WHO ARE UNABLE TO WORK
THROUGH THEIR GRIEF DESPITE THE PASSAGE OF TIME.
TYPES OF GRIEF RESPONSE
• COMPLICATED GRIEF MAY TAKE SEVERAL FORMS:
• UNRESOLVED OR CHRONIC GRIEF
• INHIBITED GRIEF
• DELAYED GRIEF
• EXAGGERATED GRIEF
GROUP ACTIVITY:
• MECHANICS:
• MAKE A 3-5 MINUTES ROLE PLAYING ABOUT THE SPECIFIC TYPE OF
COMPLICATED GRIEVING.
• EACH MEMBER SHOULD HAVE A PARTICIPATION IN THE ROLE-PLAYING
• A 10-MINUTE PREPARATION TIME WILL BE GIVEN FOR YOUR
PREPARATION
• THE CRITERIA FOR GRADING ARE:
• UNDERSTANDING OF THE TOPIC= 20 POINTS
• PERFORMANCE = 15 POINTS
• COOPERATION = 10 POINTS
• AUDIENCE IMPACT = 5 POINTS
• TOTAL = 50 POINTS
STAGES OF GRIEVING
KUBLER-ROSS’S 5 STAGES OF GRIEVING
STAGE BEHAVIORAL RESPONSE NURSING IMPLICATION
DENIAL Refuses to believe that loss is happening. Verbally support client but do not reinforce denial. Examine
Unready to deal with practical problems. your own behavior to ensure that you do not share in client’s
denial.
ANGER Client or family may direct anger at Help client understand that anger is a normal response to
nurse or staff about matters that normally feelings of loss and powerlessness. Avoid withdrawal or
would not bother them retaliation.
BARGAINING Seeks to bargain to avoid loss Listen attentively, and encourage client to talk to relieve
guilt and irrational fear. If appropriate, offer spiritual
support.
DEPRESSION Grieves over what has happened and Allow client to express sadness. Communicate non verbally
what cannot be. May talk freely. by sitting quietly without expecting conversation. Convey
caring by touch.
ACCEPTANCE Comes to term with loss. May have Help family and friends understand client’s decreased need
decreased interest in surroundings and to socialize.
support people.
STAGES OF GRIEVING
ENGEL’S STAGES OF GRIEVING
STAGE BEHAVIORAL RESPONSE
SHOCK AND DISBELIEF Refuses to accept loss. Has stunned feelings.
DEVELOPING Reality of loss begins to penetrate consciousness. Anger may be directed at
AWARENESS agency, nurses, or others
RESTITUTION Conducts rituals of mourning
RESOLVING THE LOSS Attempts to deal with painful void
Still unable to accept new love object to replace lost person or object.
IDEALIZATION Produces image of lost object that is almost devoid of undesirable features.
Represses all negative and hostile feelings toward lost object.
OUTCOME Behavior influenced by several factors: importance of lost object, degree of

dependence on relationship, degree of ambivalence, etc.
STAGES OF GRIEVING
SANDER’S PHASES OF BEREAVEMENT
PHASE DESCRIPTION BEHAVIORAL RESPONSE
SHOCK Survivors are left with feelings of confusion, Disbelief, confusion, restlessness,
unreality, and disbelief that the loss has feelings of unreality, regression, etc.
occurred.
AWARENESS OF Friends and family resume normal activities. Separation anxiety, Conflicts, Acting out
LOSS The bereaved experienced the full significance emotional expectations, prolonged stress
of their loss.
CONSERVATION / Survivors feel a need to be alone to conserve Withdrawal, Dispair, Diminished social
WITHDRAWAL and replenish both physical and emotional support, helplessness
energy.
HEALING The bereaved move from distress about living Assuming control, Identity restructuring,
without their loved one to learning to live more Relinquishing roles
independently.
RENEWAL Survivors move on to a new self-awareness, an New self-awareness, acceptance of
acceptance of responsibility for self, and responsibility, process of learning to live
learning to live without the loved one without.

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LOSS, GRIEVING,DEATH

AND POST MORTEM CARE

BILL CONRAD C. ADRICULA, RN

WHAT WAS YOUR INITIAL REACTION?

• THERE ARE MANY SOURCES OF LOSS:

• GRIEF IS THE TOTAL RESPONSE TO THE EMOTIONAL

OUTCOME Behavior influenced by several factors: importance of lost object, degree of

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